…by: Katharine Greider | Source: AARP Bulletin Today | August 28, 2009

Get Your Flu Shots.
SUMMARY
• People over age 50 should get the seasonal flu vaccine as soon as it’s available
• Many older people have some immunity to the H1N1 “swine flu” virus
• CDC’s list of priority groups for H1N1 vaccine has people age 65 and older last.

Public health officials are scrambling to prepare the nation for what promises to be a challenging double whammy of a flu season, with two types of flu—the novel H1N1, or so-called swine flu, and the usual seasonal influenza—in circulation, each entailing its own vaccine, targeted at different sets of high-risk groups.

Although it causes the same fever, lethargy, coughing and sniffles as seasonal flu, the H1N1 virus, first identified in April as swine flu, stands out from its more familiar cousin in several ways. First, the H1N1 virus has continued to spread during the warm summer months, an indication that many Americans have little or no immunity to it. Second, the new flu has struck hard among teenagers and young adults, causing a spate of outbreaks at schools and summer camps, while all but entirely sparing older people, the group most likely to develop dangerous and even lethal complications from seasonal flu.

On Monday, the White House released a report by a presidential advisory group saying that while the 2009 H1N1 flu so far appears to be no more deadly than seasonal flu, it’s so highly contagious that it’s possible as many as half of all Americans may contract the novel bug this fall and winter. Up to 90,000 people—mostly young adults, children and people with underlying conditions—could die.

Seasonal flu shot in September

Manufacturers of seasonal flu vaccine began shipping the first doses to health care providers in late July, so the shot will be available in many communities by September. Though no shortage is anticipated, demand may be up this year, so it’s a good idea to get the vaccine early [see Resources]. Immunization campaigns at workplaces and public health clinics—traditionally launched in October—may get under way sooner as providers try to clear the decks for an H1N1 shot, which won’t be available until October, according to health officials.

U.S. Centers for Disease Control and Prevention (CDC) guidelines call for more than 80 percent of the population to get a seasonal flu shot. For the first time this year, the CDC recommends every child six months to 18 years of age receive one.

But people age 50 and older have long been a top priority for seasonal-flu vaccination, with those 65 and older especially at risk. “We really want people 65 and older to know how important this [seasonal] influenza vaccine is,” Anne Schuchat, M.D., director of the National Center for Immunization and Respiratory Diseases, said in a recent press briefing. “As soon as it is available, it’s a good thing to get.”

With the H1N1 shot, it’s a different story. When a CDC advisory committee met in late July to come up with a list of priority groups for that vaccine, it placed people 65 and older dead-last. Instead, the committee said, the shot should go first to:

• Pregnant women, whose risk of hospitalization from H1N1 flu is four times the average;

• Those caring for or living with babies six months or younger, who can’t be immunized directly but need protection;

• Health care and emergency services workers;

• Everyone between the ages of six months and 24 years;

• People ages 25 to 64 who have an underlying condition like heart disease, asthma or diabetes.

Older adults and immunity

This means that, assuming health care providers follow the government’s guidance, healthy adults age 25 and older won’t even be offered the H1N1 flu shot until demand among priority groups has been met at the local level.

“I think the fall is going to be very confusing for people, and we’re going to need a lot of education about this,” says John Murphy, M.D., a professor of medicine and family medicine at Brown Medical School and chairman of the board of the American Geriatrics Society. “There are reasons why the CDC is recommending this priority order. So far, in late spring and early summer, we saw that the worst cases [of H1N1 flu] were not in people over the age of 55. The people who’ve been the sickest are those who are totally naïve to the virus. Older people are lucky enough to have some immunity to it.”

In tests run by the CDC, a third of blood samples from people over age 60 contained antibodies capable of fighting H1N1. An article published online July 13 in Nature reported that the very old—those who lived through the devastating 1918 influenza pandemic—had high levels of the antibodies in their blood.

Vaccine being tested now

The H1N1 vaccine, set for manufacture by five companies for the United States, is now being tested in trials sponsored by the National Institutes of Health to determine the optimal dose for adults and children, whether one or two shots are needed, and how the shots should be scheduled in relation to the seasonal flu vaccine. Sharon Frey, M.D., an infectious diseases specialist who leads two of the government trials at Saint Louis University, calls the undertaking “huge in terms of the speed, in terms of the number of studies that are going to be done.”

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